■对于非结核分枝杆菌(NTM)肺病(PD)的部分患者,推荐辅助肺切除术。然而,感染主要病原体的患者的长期复发率数据有限,包括鸟分枝杆菌复合体(MAC)和脓肿分枝杆菌(MABC)。
■在这项前瞻性观察研究中,我们回顾性分析了125例接受辅助肺切除术的MAC-PD(n=90)或MABC-PD(n=35)患者的数据.我们评估了微生物反应,术后并发症,复发,和全因死亡率超过中位80个月随访。
■持续培养阳性(64%)是最常见的手术指征,接着是咯血,复发性肺炎,或放射学恶化。术后并发症发生在18例(14%)患者中,没有手术相关的死亡。MAC组和MABC-PD组之间的治疗结果没有显著差异。112例(90%)患者实现了培养转化的治愈。112例患者中有37例(33%)复发,其中18例(49%)病例归因于不同NTM物种或亚种的再感染。MAC组的复发率高于MABC组(Kaplan-Meier曲线,对数秩检验,P=0.043),并且在多变量分析中与复发显着相关(调整后的风险比,2.71;95%CI,1.23-5.99)。然而,MABC-PD组的死亡率高于MAC-PD组(7/35vs4/90,P=.006).
■使用抗生素辅助肺切除术有助于减少NTM-PD患者的细菌负担并控制症状。然而,它不能防止复发,这主要是由再感染引起的。
UNASSIGNED: Adjunctive lung resection is recommended for select patients with nontuberculous mycobacteria (NTM) pulmonary disease (PD). However, data are limited on long-term recurrence rates in patients infected with major pathogens, including Mycobacterium avium complex (MAC) and Mycobacterium abscessus (MABC).
UNASSIGNED: In this prospective observational study, we retrospectively analyzed data from 125 patients with MAC-PD (n = 90) or MABC-PD (n = 35) who underwent adjunctive lung resection. We evaluated microbiological response, postoperative complications, recurrence, and all-cause mortality over a median 80-month follow-up.
UNASSIGNED: Persistent culture positivity (64%) was the most common indication for surgery, followed by hemoptysis, recurrent pneumonia, or radiologic deterioration. Postoperative complications occurred in 18 (14%) patients, with no surgery-related deaths. Treatment outcomes did not significantly differ between the MAC- and MABC-PD groups. Cure with culture conversion was achieved in 112 (90%) patients. Recurrence occurred in 37 (33%) of 112 patients, of which 18 (49%) cases were attributed to reinfection by different NTM species or subspecies. The MAC group had higher recurrence rates than the MABC group (Kaplan-Meier curve, log-rank test, P = .043) and was significantly associated with recurrence in the multivariable analysis (adjusted hazard ratio, 2.71; 95% CI, 1.23-5.99). However, mortality was higher in the MABC-PD group than the MAC-PD group (7/35 vs 4/90, P = .006).
UNASSIGNED: Adjunctive lung resection with antibiotics helps to reduce bacterial burden and manage symptoms in patients with NTM-PD. However, it does not prevent recurrence, which is mostly caused by reinfection.